I have worked with clients with diagnoses of psychosis, and part of my training included work on a psychiatric ward. As a psychotherapist I don’t diagnose nor prescribe, but I can provide support to explore your experience of psychosis and how you manage it.
I understand psychosis as partly due to environmental pressures, partly caused by past trauma or difficult events, and partly biological. I also believe there is often a spiritual aspect to psychosis which can go unrecognised. The standard medical response focusses on repressing symptoms rather than exploring either causes or the nature of the experience itself. For an alternative look at psychosis you might find the documentary ‘Crazywise’ interesting, the trailer for which you can find here.
Below is the executive summary of the report by the British Psychological Society “Understanding Psychosis and Schizophrenia” (© British Psychological Society 2017). It broadly represents the view I take, on which I base my approach.
- This report describes a psychological approach to experiences that are commonly thought of as psychosis, or sometimes schizophrenia. It complements parallel reports on the experiences commonly thought of as bipolar disorder and depression.
- Hearing voices or feeling paranoid are common experiences which can often be a reaction to trauma, abuse or deprivation. Calling them symptoms of mental illness, psychosis or schizophrenia is only one way of thinking about them, with advantages and disadvantages.
- There is no clear dividing line between ‘psychosis’ and other thoughts, feelings and beliefs: psychosis can be understood and treated in the same way as other psychological problems such as anxiety or shyness. Significant progress has been made over the last twenty years both in understanding the psychology of these experiences and in finding ways to help.
- Some people find it useful to think of themselves as having an illness. Others prefer to think of their problems as, for example, an aspect of their personality which sometimes gets them into trouble but which they would not want to be without.In some cultures, experiences such as hearing voices are highly valued.
- Each individual’s experiences are unique – no one person’s problems, or ways of coping with them, are exactly the same as anyone else’s.
- For many people, though not all, experiences such as hearing voices or feeling paranoid are short-lived. Even people who continue to experience them nevertheless often lead happy and successful lives.
- It is a myth that people who have these experiences are likely to be violent.
- Psychological therapies – talking treatments – are very helpful for many people. The National Institute for Health and Care Excellence recommends that everyone with a diagnosis of psychosis or schizophrenia should be offered talking therapy. However, currently most people are unable to access it.
- More generally, it is vital that services offer people the chance to talk in detail about their experiences and to make sense of what has happened to them. Surprisingly few currently do. Professionals should not insist that people accept any one particular framework of understanding, for example that their experiences are symptoms of an illness.
- Many people find that ‘antipsychotic’ medication helps to make the experiences less frequent, intense or distressing. However, there is no evidence that it corrects an underlying biological abnormality. Recent evidence also suggests that it carries significant risks, particularly if taken long term.
- Psychosis is often related to experiences of abuse, deprivation, victimisation and racism.
- There is also racism and other forms of discrimination in services. People from black and minority ethnic backgrounds, particularly young men, are more likely than others to be diagnosed with schizophrenia, more likely to experience compulsion, more likely to be given powerful drugs and less likely to be offered psychological therapy. In general people from disadvantaged backgrounds also get a worse deal from services.
- Services need to change radically, and we need to invest in prevention by taking measures to reduce abuse, deprivation and inequality.